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Using precision medicine to individualize healthcare

Key, Betty A. EdD, MSN, RN, CCRN; Mumba, Mercy PhD, RN, CMSRN

doi: 10.1097/01.NURSE.0000569760.88666.61
Feature: NEW HORIZONS
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Abstract: The Precision Medicine Initiative (PMI) is a government initiative to encourage individualized care. This article provides a snapshot of precision medicine and its implications for patients and study participants, as well as the PMI and the role of nurses as educated patient advocates.

Explore nursing's role in the Precision Medicine Initiative, which is intended to encourage individualized care and increase the number of minority and underrepresented patients in clinical research.

Betty A. Key and Mercy Mumba are assistant professors at the University of Alabama Capstone College of Nursing in Tuscaloosa, Ala.

The authors have disclosed no financial relationships related to this article.

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PRECISION MEDICINE IS NOT A NEW TOPIC in healthcare. After President Obama's 2015 State of the Union address, however, the concept began to gain momentum and more than $200 million was earmarked for increased research into disease prevention, management, and treatment.1 The Precision Medicine Initiative (PMI) is a government initiative to encourage individualized care.2 One of the PMI's goals is to increase the number of minority and underrepresented patients in clinical research in the US through the All of Us initiative.3 Doing so will make research findings more pertinent to a wider patient population.

It is up to nurses to stay abreast of progress in precision medicine and contribute positively to the awareness of such advancements. This article provides a snapshot of precision medicine and its implications for patients and study participants, as well as the PMI and the role of nurses as educated patient advocates.

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Background

Due to strides in genomic research over the last 10 years, personalized or targeted approaches are changing what nurses see in patient care, especially in oncology.4 Nurses witness how different treatments, such as drug therapy, may work for one patient and be ineffective for another. Precision medicine targets these disparities to promote individualized care and positive patient outcomes.

In May 2018, the National Institutes of Health (NIH) launched the All of Us initiative as part of the PMI to increase awareness of precision medicine and include underrepresented patient populations, such as Blacks, Hispanics, and Asians, in clinical studies. It was established with the goal of recruiting 1 million participants from different socioeconomic, ethnic, racial, and medical backgrounds, as well as age and geographic location.3 With involvement and participation in clinical studies, underrepresented groups can bring their respective voices to the research community.

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What is precision medicine?

Precision medicine can be illustrated with the example of an eye exam. The eye health services provider writes a prescription for corrective eye glasses or contact lenses based on exam results for that patient. Given to another patient, that same prescription would not produce clear vision. Similarly, precision medicine works by tailoring care to individual patients.

Although clinical research typically yields positive results for the overall population, researchers have realized the significance of individualized and genomic-specific research to benefit those who may not have seen the same results.5 They are now focusing on research that will help clinicians prescribe medications and treatments that are most likely to be effective for individual patients.

To reveal specific differences in a population, studies must include individuals from diverse backgrounds. NIH has funded organizations, such as the American Association of Colleges of Nursing (AACN), as well as many historically Black fraternities and sororities, to target different geographical locations and populations and raise awareness about the All of Us initiative.

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Precision medicine and nursing

Due to unethical research in the past, such as the Tuskegee syphilis study, inequities faced by ethnic and racial groups involved with clinical research in the US and around the world have contributed to distrust and decreased participation from the Black and Hispanic communities.6 This has furthered underrepresentation in both medical and clinical trials.7 Researchers must ensure underrepresented patient populations that, as research participants, their rights are protected and safeguards are now in place to prevent unethical practices.6 For a detailed discussion, see “Protecting the Rights of Patients, Nurses, and Others Participating in Research” in the July issue of Nursing2019.

The All of Us research program gathers data from 1 million people in the US to accelerate research and improve health and well-being. One of the primary goals of the initiative is increased ethnic, racial, and geographic diversity among participants involved in clinical research. Recruiting and enrolling more underrepresented patients in research studies will improve future treatments and pharmacotherapy. Similarly, another important arm of precision medicine, pharmacogenomics, examines an individual's genetic response to medication and also requires diverse study participants.8

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Nursing advocacy

According to the annual Gallup poll, nurses have been ranked first in public perceptions of honesty and ethical standards for the last 17 years.9,10 As such, clinical nurses, community nurses, advanced practice nurses, nurse educators, administrators, and nurse researchers are all ideally positioned to disseminate information and assist with recruitment. Additionally, research into precision medicine provides nurses a platform for patient advocacy, ultimately leading to health policy changes and extending to the community and country.

Although they may not be participating in the study to witness informed consent, clinical nurses may have patients who are considering genomic or pharmacogenomic research. They should be knowledgeable about the PMI to serve as patient advocates; for example, by encouraging patients from underreported backgrounds to participate in research studies.

With the appropriate training, advanced practice nurses working with underserved patient populations can discuss the benefits and implications of precision medicine by acting as health literacy translators and interpreting genetic test results.4 Similarly, clinical nurses remain with patients and help with questions or uneasiness regarding genetic testing.6 In many instances, they can also verify that patients are taking their medications as prescribed and recommend individuals who may benefit from pharmacogenomics.

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Looking to the future

The science of genomics is evolving to personalize treatments such as drug therapy for better patient outcomes, and the nursing profession has entered a new era of precision medicine. As the largest population of healthcare providers, nurses are equipped to offer education on genomic medicine to patients and families. This includes its benefits and implications for both individuals and their respective racial and ethnic communities.

Similar to patient education on disease processes, nurses' knowledge and understanding of precision medicine will soon become a required competence. Nurses who stay abreast of progress in the field can contribute positively to the awareness of such advancements. Nurses can recommend that patients discuss precision medicine and its impact on their diagnoses, treatments, and outcomes with their healthcare providers. Partnering with researchers and scientists, nurses can help connect diverse populations with the All of Us initiative, potentially improving outcomes for a wide range of patients.

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REFERENCES

1. Data security and President Obama's precision medicine initiative. Penn Bioeth J. 2015;11(1):6.
2. The White House Archives. The precision medicine initiative. 2015. https://obamawhitehouse.archives.gov/precision-medicine.
3. US Department of Health and Human Services: National Institutes of Health. About the All of Us research program. 2019. https://allofus.nih.gov/about/about-all-us-research-program.
4. Vorderstrasse AA, Hammer MJ, Dungan JR. Nursing implications of personalized and precision medicine. Semin Oncol Nurs. 2014;30(2):130–136.
5. Oh SS, Galanter J, Thakur N, et al Diversity in clinical and biomedical research: a promise yet to be fulfilled. PLoS Med. 2015;12(12):e1001918
6. Mick J. Protecting the rights of patients, nurses, and others participating in research. Nursing. 2019;49(7):26–35.
7. Bole K. Diversity in medical research is a long way off, study shows. University of California San Francisco. 2015. http://www.ucsf.edu/news/2015/12/401156/diversity-medical-research-long-way-study-shows.
8. Genetics Home Reference. What is the difference between precision medicine and personalized medicine? What about pharmacogenomics? National Institutes of Health. 2019. https://ghr.nlm.nih.gov/primer/precisionmedicine/precisionvspersonalized.
9. Riffkin R. Americans rate nurses highest on honesty, ethical standards. Gallup. 2014. https://news.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx.
10. Clinical rounds. Nursing. 2019;49(3):21–23.
Keywords:

diversity; genomics; pharmacogenomics; PMI; precision medicine; precision medicine initiative

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